Poverty and premature death still firmly linked

Poverty is as a strong a predictor of premature death today as it was a century ago, according to findings from a study in England and Wales.

Despite all the medical, public health, social, economic, and political changes over the 20th century, patterns of poverty and mortality and the relations between them remain firmly entrenched, states Dr. Ian N. Gregory, from Lancaster University, UK.

Gregory reached this conclusion after analyzing census and death data for 634 districts from the 1900s and directly comparing it with data from 2001.

During the twentieth century, major improvements in death rates were seen in England and Wales, the report indicates.

In the early 1900s, 33 percent of all deaths involved children under 5 and just 13 percent occurred in people over 75 years. By 2001, less than 1 percent of deaths involved young children and 65 percent occur in people over 75. Life expectancy also improved dramatically during the period, climbing from 46 to 77 years for men and from 50 to 81 years for women.

The most common causes of death also changed in the last century, Gregory notes. Infectious and parasitic disease, as well as lung problems, were the main causes in the early 1900s. By 2001, cancer, heart disease, and stroke were the dominant causes.

Finally, the meaning of poverty has changed. In the past, it meant barely having the necessities for existence, but now poverty has become more of a relative term used to compare one person's income or deprivation with another's.

Nonetheless, all of these changes have had little impact on the strong association between poverty and death.

One factor that may, in part, explain the steady association is that modern diseases have a possible long-term link to unhealthy living conditions in the distant past, Gregory states. The strong association between modern deaths from lung cancer and 1900s (deaths) suggests that this might in part be a cultural effect caused by the long-term (rate) of smoking in poorer areas.

SOURCE: BMJ Online First, September 11, 2009.